MELD评分系统对血浆置换治疗肝衰竭患者疗效的评价

目的应用终末期肝病评分模型(MELD)评价血浆置换治疗肝衰竭的临床疗效。方法 131例肝衰竭患者在内科综合治疗基础上进行血浆置换术(PE)治疗,观察治疗前后血常规、肝功能、肾功能、凝血指标和MELD计分的变化。结果在PE治疗前后丙氨酸氨基转移酶(406.2±591.6u/l和88.9±93.4u/l)、总胆红素(407.2±144.1μmol/l和287.6±150.4μmol/l)和凝血酶原时间(24.9±14.7s和19.7±7.1s)的变化有显著性统计学差异(P均<0.05);MELD计分小于40的患者经PE治疗后MEDL计分显著下降,差异有统计学意义(P<0.05),而MELD计分大于40的患者在治疗后MELD无显著性变化(P>0.05);入院时MELD计分在0~20分、20~30分、30~40分和大于40分的患者,其病死率分别为17.8%、37.3%、60.0%和100.0%。结论血浆置换治疗肝衰竭患者能有效改善血生化指标和MELD计分,MELD评分系统可用于对肝衰竭患者预后的判断。

Model for end-stage liver disease to predict the clinical outcomes of patients with hepatic failure after plasma exchange

Objective To evaluate the model for end- stage liver disease （MELD） for predicting the clinical outcomes of patients with hepatic failure after plasma exchange （PE）. Method 131 patients with hepatic failure were treated with plasma exchange. Blood routine,liver function, renal function and coagulation index were observed pre- and post-treatment, and the model for end-stage liver disease was also evaluated. Results There were obvious exchanges of ALT （406.2±591.6u/l vs. 88.9±93.4u/l）,total serum bilirubin （407.2±144.1μmol/1 vs. 287.6±150.4μmol/1） and prothrombin time （24.9±14.7s vs. 19.7±7.1s） in the 131 patients with liver failure before and after PE （P〈O.05）;The improvement was found in patients with MELD score less than 40（P〈0.05）;The fatality rates in patients with MELD score at less than 20,20 to 30,30 to 40 and greater than 40 were 17.8%,37.3%, 60.0% and 100.0%,respectively. Conclusion Plasma exchange can significantly improve clinical outcomes of patients with liver failure ,especially in those at early to middle stage disease.